At 170 years, N.H. Hospital has much to celebrate

But many challenges remain in supporting state’s psychiatric programs

By Kenneth Norton

Published: November 16, 2012

As hurricane Sandy blew into our state, a small celebration took place.

New Hampshire Hospital, our state psychiatric facility, celebrated its 170th birthday, having begun operations Oct. 29, 1842. While much at the hospital has changed over those years, one constant that has remained is the staff’s commitment to treat people with dignity, compassion and respect.

At its peak during the late 1950s, the hospital census was about 2,700 adults. Today, the hospital has a maximum census of 150 adult beds, with an average length of stay of about 10 days. Since its inception, the hospital has treated over 80,000 individuals.

New Hampshire’s 1983 Nardi-Wheelock report resulted in the development of more community-based mental health services in our state. The governor and legislature decided to close the overcrowded and rundown Brown building and build a much smaller inpatient hospital, which opened in 1990.

They also contracted with Dartmouth Medical School to provide highly trained psychiatrists to lead the treatment teams. During the early 1990s, New Hampshire was recognized nationally for having the best mental health services system in the country.

The success in building a smaller hospital facility was dependent on a statewide system of community supports, including the development of regional designated receiving facilities (DRFs) at local hospitals, which could provide voluntary or involuntary short-term crisis stabilization and care closer to people’s homes, families and community supports. Unfortunately, this vision was never fully realized, and most of the DRFs that did open have since closed due to funding reductions that have also negatively impacted other important community supports for people with mental illness.

This, combined with admission rates which have more than doubled since the new hospital was built and cuts that have forced the hospital to reduce beds, has resulted in a situation in which people in crisis spend days and sometimes weeks in emergency departments awaiting a bed at New Hampshire Hospital.

These have been contributing factors in a suit filed by legal advocates and the Department of Justice against the state for alleged violations of the Americans with Disabilities Act.

Despite these challenges, there was still much to celebrate on New Hampshire Hospital’s birthday.

The hospital has a competent and dedicated staff who are passionate about providing high-quality services. It was recently reaccredited by the Joint Commission of Hospital Accreditation — the gold standard for hospitals. The hospital’s commitment to quality and improving services is also evidenced by an innovative partnership with NAMI NH — the National Alliance on Mental Illness -- in which family members are trained as quality control monitors and can go into the hospital at any time and check on treatment programs, facilities and food and talk with staff and patients to hear concerns they have. The hospital also has begun an innovative discharge planning process to improve continuity of care that will, hopefully, reduce readmissions.

The hospital also continues to be a teaching facility. In addition to training Dartmouth psychiatric and medical residents, it also trains art therapists, nurses, psychologists, occupational therapists and social workers.

While not everyone has had a positive experience, over the 30 years I have worked in the mental health field, I have heard on numerous occasions that the care their loved one received at New Hampshire Hospital was of a higher quality than at a private psychiatric hospital.

As we celebrate and reflect on the hospital’s 170 years, we face many challenges. Its success is dependent on the success of our 10 regional community mental health centers as well as local hospitals and other private providers in being funded at a level that can provide effective treatment and supports for people with mental illness.

It will be incumbent on our new governor to work with the Legislature to insure community supports are in place to protect our most vulnerable citizens and promote recovery from mental illness.

Kenneth Norton is executive director of the Concord-based National Alliance on Mental Illness New Hampshire.

This article appears in the November 16 2012 issue of New Hampshire Business Review